The recent International AIDS Society (IAS) conference drew over 24 000 delegates to Mexico City, and the presentations revealed continued reductions in morbidity and mortality rates through access to effective antiretroviral therapy (ART). However, a number of studies also reported that mortality rates remain high among those with HIV infection. This occurs not only in resource-poor settings where, arguably, poverty and poor access to testing and treatment are drivers of mortality. A number of factors were associated with HIV mortality in these emerging studies: late testing and treatment initiation in advanced disease stages, treatment resistance/failure, poor adherence, and emerging comorbidities such as liver failure, malignancies, and cerebrovascular events. Further reductions in mortality (in the absence of curative options) may be achieved through improved access and adherence to disease-modifying interventions (for example, health promotion to increase testing uptake, protocols to better manage initiation and adherence to therapy) as well as advances in new effective therapeutic regimens. Meanwhile, patients are dying in large numbers; 2 000 000 patients with HIV disease are estimated to have died during 2007 (website: http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp211_234_en.pdf), and HIV-related mortality will continue to be a global public health challenge. A number of studies reported new data on mortality at the 17th IAS conference. For example, in the Caribbean and Latin America, in the first year of ART initiation, patients had an 8.2% probability of dying [1]. In Botswana, across ART rollout programs, 9% of those accessing treatment died in a 6-year observational study [2]. In the first 48 weeks of starting treatment in Mexico, 18.9% of patients died [3]. In Myanmar, 11% of tuberculosis-infected patients died in a 20-month period [4]. In the United States, since the advent of ART, children accessing treatment have had a 6% 10-year probability of death [5]. In India, observational follow-up of patients starting first-line therapy found only 71% alive after 2 years, with the majority of deaths within the first 6 months [6]. We conducted a systematic review of the 5071 abstracts selected for oral and poster presentation at the Mexico meeting. Using the search terms ‘terminal, palliative, dying, end of life, hospice, and advanced’ (intersected with ‘or’), we identified only 19 abstracts reporting the needs, provision of care, or terminal care outcomes of advanced or dying patients or of both. Therefore, although 6.1% of those infected globally died during 2007, only 0.004% of abstracts at the conference reported data on the care of these patients. Although many studies reported mortality data, care of the dying was rarely a substantive field of research. Further, presentations of longitudinal datasets often aggregated those lost to follow-up with those who died. We suggest that these are two very different groups, and that although the first group may indeed contain many of the second, patients should never be abandoned or considered ‘lost’ to clinicians or clinical researchers simply because they appear to be dying. We believe that our appraisal of the state of HIV research demonstrates a very concerning lack of interest in the appropriate, humane, and effective care of patients dying with HIV disease. A systematic review demonstrated that symptom control, anxiety, insight into disease prognosis and impending death, and spiritual well-being can all be significantly improved under palliative care for people with HIV infection [7]. People with advanced HIV disease (and their families, who require bereavement support to prevent poor physical and psychological morbidity) deserve both clinical and research attention and have the right to best quality care and quality of life from the point of diagnosis, through treatment and into the end of life.